Toolkits & Technical Manuals; A Knowledge Gap Hiding in Plain Sight
This summer, while working for the World Health Organization (WHO) Poland Country office I ran in to my first health policy toolkit: The WHO Technical Manual on Tobacco Tax Administration (WHO, 2010). For the purposes of this blog post, I am using the term “toolkit” to refer to practical tools that have been developed to be informed by evidence, and offer assistance to policy makers. In the Knowledge to Action Cycle model, this would represent to “Tools & Products” portion of the knowledge creation triangle (Graham, et al., 2006).
Toolkits are a ubiquitous product in the health policy field. A search of CINAHL using the term “toolkit” reveals over 700 results, with only very few articles discountable as not health policy toolkits. Unfortunately, it seems that there is very little in the way of reviews of the form of writing itself; most articles are simply toolkits offered up for one health aim or another.
Aside from academic searches, several websites host repositories of toolkits available for all types of health policy issues. The website www.k4health.org, represents the web presence for the organization Knowledge 4 Health. Their Toolkits section contains 67 different toolkits ranging in such disparate subjects as mental health and prevention of post-partum-hemorrhage. The WHO also maintains many different policy toolkits, again, ranging in subject from things like sex work to chemical hazard prevention.
Most toolkits, and all the toolkits I’ve reviewed in preparation for this blog post, follow the standard academic format of providing a background evidence section at their beginning. As a pedagogical structure, this explains exactly why the subsequent portions are written the way they are. This differentiates this form of writing from briefings or instruction manuals, which might not explicitly provide a review of literature.
Next, toolkits that I’ve reviewed break down the relevant task into steps or benchmarks that can be achieved by the implementer. In this section, the toolkit becomes much more like an instruction manual, laying out in clear, unequivocal language what must be done. Some toolkits will present these steps in more interpretable ways (ex. (K4Health, 2013)) while others will be focused and very exacting (ex. (WHO, 2010)).
A lack of reviews and evidence around this writing style makes the tool difficult to analyze. For example, should steps be more exact or more general? Which of these approaches should be used in which situation? What’s more, when should this type of toolkit be created, and towards what kinds of ends? Additionally, I wonder about how often these toolkits are used. I have encountered toolkits that come as part of mandated government programs, however much of this work is prepared by researchers and allowed to be passively disseminated. For example, with the www.k4health.org website, I wonder how often those 67 toolkits get downloaded, and more importantly, how often they get implemented. Indeed, even the WHO’s role is one of diplomacy – gently urging it’s member states to adopt the procedures defined in its toolkits.
Despite the prevalence of toolkits in public health practice, there is much research, development and review that remains to be done on this writing style.
WHO. (2010). The WHO Technical Manual on Tobacco Tax Administration. Geneva: WHO Press.
WHO. (2010). Toolkit for Scaling Up Health Innovations. France: WHO Press.
Graham, I. D., Logan, J., Harrison, M. B., Straus, S. E., Tetroe, J., Caswell, W., et al. (2006). Lost in Knowledge Translation: Time for a Map? The Journal of Continuing Education in the Health Professions , 26, 13-24.
K4Health. (2013). A Gorecasting Guide for New and Underused Methods of Family Planning. K4Health.